RESUMEN
BACKGROUND: Neuropathy is a common diabetic complication that can result in significant disability. Few treatment options exist to reverse this process. METHODS: We conducted a one-way crossover cohort study comparing intensive medical treatment and islet cell transplantation for type 1 diabetes on the change in nerve conduction velocity over six years. FINDINGS: For subjects with some neuropathy at baseline (Z score below -1), nerve conduction velocity significantly improved post-transplant (slope (0.073±0.042) while it worsened in medically treated patients (-0.136±0.081) (p<.05). INTERPRETATION: Islet cell transplantation improves nerve conduction velocity and could be further investigated as a treatment for neuropathy in type 1 diabetes.
Asunto(s)
Cuidados Críticos/métodos , Diabetes Mellitus Tipo 1/complicaciones , Neuropatías Diabéticas/terapia , Trasplante de Islotes Pancreáticos/métodos , Conducción Nerviosa/fisiología , Adulto , Estudios Cruzados , Diabetes Mellitus Tipo 1/terapia , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Factores de TiempoRESUMEN
BACKGROUND: The effect of islet cell transplantation (ICT) on the progression of diabetic microvascular complications is not well understood. METHODS: We have conducted a prospective, crossover, cohort study comparing ICT with intensive medical therapy on the progression of diabetic nephropathy, retinopathy, and neuropathy. RESULTS: The rate of decline in glomerular filtration rate is slower after ICT than on medical therapy. There was significantly more progression of retinopathy in medically treated patients than post-ICT. There was a nonsignificant trend for improved nerve conduction velocity post-ICT. CONCLUSIONS: ICT is associated with less progression of microvascular complications than intensive medical therapy. Multicenter, randomized trials are needed to further study the role of ICT in slowing the progression of diabetic complications.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/terapia , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/prevención & control , Progresión de la Enfermedad , Insulina/uso terapéutico , Trasplante de Islotes Pancreáticos , Adulto , Estudios de Cohortes , Estudios Cruzados , Angiopatías Diabéticas/fisiopatología , Nefropatías Diabéticas/epidemiología , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , Masculino , Microvasos/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Diabetic retinopathy is a major complication of type 1 diabetes and remains a leading cause of visual loss. There have been no comparisons of the effectiveness of intensive medical therapy and islet cell transplantation on preventing progression of diabetic retinopathy. METHODS: The British Columbia islet transplant program is conducting a prospective, crossover study comparing medical therapy and islet cell transplantation on the progression of diabetic retinopathy. Progression was defined as the need for laser treatment or a one step worsening along the international disease severity scale. An interim data analysis was performed after a mean 36-month follow-up postislet transplantation and these results are presented. RESULTS: The medical and postislet transplant groups were similar at baseline. Subjects after islet transplantation had better glucose control than the medically treated subjects (mean HbA1c 6.7%+/-0.9% vs. 7.5+/-1.2, P<0.01) and were C-peptide positive. Progression occurred significantly more often in all subjects in the medical group (10/82 eyes, 12.2%) than after islet transplantation (0/51 eyes, 0%) (P<0.01). Considering only subjects who have received transplants, progression occurred in 6/51 eyes while on medical treatment and 0/51 posttransplant (P<0.02). CONCLUSIONS: Progression of diabetic retinopathy was more likely to occur during medical therapy than after islet cell transplantation.
